Dir, Managed Care

Phoenix Children's Hospital, Inc.; Phoenix (AZ); On-site; USD 180,000 - 240,000; Full time

Job summary

Phoenix Children's Hospital, Inc. seeks a Director of Managed Care to lead the contract lifecycle, including negotiation, implementation, and coordination of third-party payer agreements for the enterprise.

The role oversees Provider Enrollment and Payer Relations, ensuring timely enrollment and productive relationships with payers. The position reports to the VP, Managed Care and supports PC, PCMG, and PCCN contracts.

Qualifications

• Bachelor's degree or five years of managed care supervisory experience required.
• Master's degree preferred.
• Ten or more years of managed care experience required.
• Five years supervisory experience required.
• Three years of comprehensive managed care contracting experience in IDN/ACO/health plan.
• Extensive knowledge of contracting negotiations, reimbursement methodologies, risk contracts, and related regulations.
• Experience with facility and professional billing systems, CPT/HCPCS codes, and revenue codes.

Responsibilities

• Directs all contracting activities for the enterprise-wide payer contract portfolio.
• Oversees enrollment of facilities and employed providers with payers.
• Manages payer relations to maintain productive relationships for contract development.
• Educates network providers on managed care principles and contract changes.
• Leads cross-functional teams to implement contracting strategies and negotiations.
• Performs miscellaneous job-related duties as requested.

Education

Bachelor's degree in finance, health administration, or related field; OR five (5) years of managed care supervisory experience

Master's degree

Tools

Microsoft Office (Word, Excel, Outlook, PowerPoint)

Job description

The Director, Managed Care is responsible for the managed care contract life cycle, including, negotiation, implementation, coordination of third party payer agreements and managed care contracting for the Phoenix Children`s enterprise. These agreements may represent contractual relationships with the public sector, commercial health plans, or employer-sponsored health plans in a fee-for-service, value-based, or risk arrangement. The Director, Managed Care will have oversight of Provider Enrollment, ensuring timely and accurate enrollment of facility and employed providers with third party payers. The Director, Managed Care will have responsibility for Payer Relations, maintaining positive working relationships necessary to effectively and efficiently obtain and operationalize contracts. This position reports to the Vice President, Managed Care and supports PC, PCMG and PCCN contractual relationships.

Position Duties

• Directs all contracting activities for the enterprise-wide payor contract portfolio.
  Directs contracting staff activities to achieve optimal contract financial and operational outcomes as well as effective contract management. Responsible for contract negotiations, including rates, payment methodologies, contract language and value based payment programs in accordance with internal control processes for contract review, approval and signature. Ensures contracts are negotiated within established parameters and acceptable time frames for maximum performance. Makes recommendations for contract strategies.
  • Oversees the activities of the Provider Enrollment staff.
    Oversees the activities of the Provider Enrollment team to ensure timely and accurate enrollment of facilities and employed providers with contracted payers. Ensure compliance with credentialing, recredentialing and delegated credentialing requirements related to Provider Enrollment. Monitor and update provider demographic information.
    • Educates network providers and staff on key managed care principles, market trends, and opportunities for improvement in support of enterprise goals and objectives
      Prepares and provides training on pertinent subject matter to network providers. Proactively communicates and educates operational areas on contract changes, policy updates, etc. To ensure staff have information needed to successfully implement and operationalize agreements. Participates in or conducts presentations as needed.
      • Coordinates and leads activities using a collaborative and team approach.
        Demonstrates attention to detail, strong interpersonal skills, and project management skills to effectively conduct team meetings, engage team members, secure cooperation, and accomplish department goals and objectives. Handles multiple projects and ensures teams perform as needed under tight deadlines with a focus on effective implementation, communication and follow-up. Maintains collaborative, team relationships with peers and colleagues in order to effectively contribute to the working group`s achievement of goals and to help foster a positive work environment.
        • Plays a key role in managing relationships for network hospitals, physicians, ancillary providers and vendors related to managed care agreements.
          Ensures contracting, payor relations and provider services staff develop positive, effective relationships with internal and external customers. Provides direction needed by staff to interface effectively with internal staff, providers, payors, and health plans in negotiations, problem resolution and dispute management.
          • Performs miscellaneous job related duties as requested.

  Phoenix Children's Mission, Vision, & Values

  Mission

  To advance hope, healing and the best healthcare for children and their families

  Vision

  Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

  We realize this vision by:

  • Offering the most comprehensive care across ages, communities and specialties
  • Investing in innovative research, including emerging treatments, tools and technologies
  • Advancing education and training to shape the next generation of clinical leaders
  • Advocating for the health and well-being of children and families
  Values
  • We place children and families at the center of all we do
  • We deliver exceptional care, every day and in every way
  • We collaborate with colleagues, partners and communities to amplify our impact
  • We set the standards of pediatric healthcare today, and innovate for the future
  • We are accountable for making the highest quality care accessible and affordable

  Position Qualifications

  Please review the following qualifications and specify whether you meet each of the requirements listed.

  Education

  Do you meet this requirement or have the ability to obtain it
  within the timeframe listed in the requirement? 1. Bachelor`s degree in finance, health administration, or related field; OR five (5) years of managed care supervisory experience.
  Required Yes No 2. Master`s degree
  Preferred Yes No

  Experience

  Do you meet this requirement or have the ability to obtain it
  within the timeframe listed in the requirement? 1. Ten (10) years managed care experience.
  Required Yes No 2. Five (5) years supervisory experience.
  Required Yes No 3. Three (3) years comprehensive managed care contracting for an integrated delivery system, ACO, multi-hospital system, or health plan.
  Required Yes No 4. Extensive knowledge, experience and expertise in managed care contracting negotiations, language, modeling analytics, reimbursement methodologies for hospitals, physicians and ancillary providers, shared savings and risk contracting, managed care regulations, quality metrics and risk contracting.
  Required Yes No 5. Experience and/or familiarity with facility and professional billing systems and processes. Knowledge of CPT, HCPCS, facility revenue codes, and diagnosis codes.
  Required Yes No

  Special Skills

  Do you meet this requirement or have the ability to obtain it
  within the timeframe listed in the requirement? 1. In depth knowledge of managed care concepts, including finance, information systems, billing and claim adjudication, regulatory environment, and provider community.
  Required Yes No 2. Excellent skills with Microsoft Office, especially Word, Excel, Outlook and PowerPoint.
  Required Yes No 3. Strong verbal and written communication skills. Articulate and able to speak with credibility to small or large groups.
  Required Yes No 4. Strong project management experience.
  Preferred Yes No

  Additional Requirements

  Do you meet this requirement or have the ability to obtain it
  within the timeframe listed in the requirement? 1. Health Care Financial Management Association (HFMA) certification.
  Preferred Yes No

  Physical Requirements & Occupational Exposure/Risk Potential

  1. Physical Requirement - Climbing -Occasionally 2. Physical Requirement - Feeling (sensing textures and temperatures) -Occasionally 3. Physical Requirement - Fine Motor Skills (pinching, gripping, etc) -Occasionally 4. Physical Requirement - Hearing -Constantly 5. Physical Requirement - Pushing/pulling -Occasionally 6. Physical Requirement - Reaching -Occasionally 7. Physical Requirement - Sitting -Frequently 8. Physical Requirement - Standing -Occasionally 9. Physical Requirement - Stooping/crouching/kneeling/crawling -Occasionally 10. Physical Requirement - Talking -Frequently 11. Physical Requirement - Walking -Frequently 12. Physical Requirement - Near Vision -Frequently 13. Physical Requirement - Far Vision -Occasionally 14. Physical Requirement - Color Discrimination -Occasionally 15. Physical Requirement - Use of keyboard, mouse and/or computer equipment -Frequently 16. Physical Requirement - Lift up to 35 pounds without assistance -Occasionally 17. Physical Requirement - Lift more than 35 pounds without assistance -Occasionally 18. Occupational Exposure/Risk Potential - Inside office environment -Applicable I have reviewed the qualifications, physical requirementsand occupational exposure/risk potential for this position and wish to apply I Agree